Helicobacter pylori (commonly just called H. pylori) is a germ (bacterium). It can infect the lining of the stomach and duodenum (the first part of the intestine). Over half the world’s population has it. It is more common in developing countries. Why and when people become infected is unknown. It is sometimes present in children and some scientists believe we acquire it at a very young age. Once one is infected, unless treated, the infection usually stays for the rest of your life.

Silent presence
Most people who are infected with H. pylori have no symptoms or problems caused by the infection. These people do not know that they are infected. A number of H. pylori germs (bacteria) may just live harmlessly in the lining of the stomach and duodenum.

Stomach and duodenal ulcers
The most common cause of duodenal and stomach ulcers is H Pylori. About 3 in 20 people who are infected with H. pylori develop an ulcer. An ulcer occurs where the lining of the stomach or duodenum is damaged by the acid made in the stomach and the underlying tissue is exposed. If we could see inside our gut, an ulcer looks like a small, red crater on the lining of the stomach or duodenum.
The exact way H. pylori causes ulcers in some infected people is not totally clear. Your stomach normally produces acid to help with the digestion of food and to kill bacteria. This acid is corrosive. Some cells on the inside lining of the stomach and duodenum produce a natural mucous barrier which protects the lining of the stomach and duodenum from this acid. There is normally a balance between the amount of acid that we make and the mucous defence barrier. An alteration in this balance allowing the acid to damage the lining of the stomach or duodenum may develop into ulcer. In some cases H. pylori causes inflammation in the lining of the stomach or duodenum. This is called gastritis and may lead to other conditions such as vitamin B12 deficiency. In gastritis the mucous defence barrier to be disrupted in some way (and in some cases the amount of acid to be increased). The acid thus causes inflammation and ulcers.

Dyspepsia without ulcer
This is a condition where we have recurrent bouts of indigestion (dyspepsia) which are not caused by an ulcer or inflammation. It is sometimes called functional dyspepsia. H. pylori is sometimes found in people with non-ulcer dyspepsia. Getting rid of H. pylori cures improves most cases.

● Abdominal pain with burning or gnawing sensation
● Pain is often made worse with empty stomach; night time pain is common.
● Poor appetite
● Weight loss.
● Heart burn.
● Indigestion (dyspepsia)
● Belching.
● Nausea.
● Vomiting
● Blood in Stool

Long-term infection with H. Pylori increases the risk of developing stomach cancer. However, it has to be stressed that the vast majority of people with H. pylori do not get stomach cancer. The increased risk is small. One’s risk may be greater if one has H. pylori in addition to having a first-degree relative (mother, father, brother, sister or child) who has been diagnosed with stomach cancer.

This is a rare and unusual type of stomach cancer. Infection with H. pylori plays a role in this condition developing.

Various tests can detect H. pylori:
A breath test can confirm that one has a current H. pylori infection. A sample of one’s breath is analysed after one takes a special drink. Prior to this test one should not have taken any antibiotics for at least four weeks. Also, one should not have taken a proton pump inhibitor (PPI) or H2-receptor antagonist medicine for at least two weeks. (These are acid-suppressing medicines.) Also, one should not eat anything for six hours before the test. The reason for these rules is because the medication and food can affect the test result.

An alternative test is the stool antigen test. In this testa pea-sized sample of one’s stools (faeces) is given which is tested for H. pylori. Prior to this test one should not have taken any antibiotics for at least four weeks. Also, one should not have taken a PPI or H2-receptor antagonist acid-suppressing medicine for at least two weeks.

A blood test can detect antibodies to H. pylori. This is sometimes used to confirm that one is, or has been, infected with H. pylori. However, it can take up to a year for this test to become negative once the infection has cleared. So, it is no use to confirm whether treatment has cleared the infection (if this needs to be known). If needed, the breath test or stool antigen test is usually used to check if an infection has cleared following treatment.

Some times a small piece (biopsy) taken at the time of endoscopy can be used to confirm the diagnosis. By undergoing endoscopy onw will also come to know about ulcer/inflammation/cancer.

H. pylori is exterminated by certain antibiotics. However, a combination of medicines is needed to get rid of it completely. This is referred to as combination therapy although because it eradicates (gets rid of) the germ it is also referred to as eradication therapy. One needs to take two antibiotics at the same time. In addition, one needs to take a medicine to reduce the acid in the stomach. This allows the antibiotics to work well in the stomach. One needs to take eradication therapy for one/two week. It is important to take all the medication exactly as directed and to take the full course.
Eradication therapy clears H. pylori in up to 9 in 10 cases if it is taken correctly for the full course. If one does not take the full course then the chance of clearing the infection is reduced. A second course of eradication therapy, using different antibiotics, will usually work if the first course does not clear the infection.
Extermination or Eradication therapy is sometimes called triple therapy as it involves three medicines – two antibiotics and an acid-suppressing medicine.

Repeated indigestion symptoms (recurring dyspepsia) If one has recurring dyspepsia (dyspepsia which clears up and then comes back again), it is common practice to test for H. pylori before doing any other tests. If H. pylori is found, eradication treatment is often given. The exact diagnosis may not be known. For example, it might not be clear if the dyspepsia is caused by a duodenal or stomach ulcer, or non-ulcer dyspepsia. These can only be confirmed by having a look down into the gut with a test called gastroscopy (endoscopy). However, if symptoms go after treatment for H. pylori then that is the end of the matter. You does not need further tests such as gastroscopy. One will not know exactly what caused the symptoms but this does not matter if the symptoms have gone.

If one is in one of the following groups, one may be offered a test for H. pylori and offered treatment with eradication therapy if it is found. If one:
● Has atrophic gastritis (inflammation of the stomach lining).
● Has an operation to remove a stomach cancer
● Has a MALToma.
● Has a duodenal or stomach ulcer.
● Eradication therapy will usually cure the ulcer.
● is taking, or is about to take, long term anti inflammatory drugssuch as diclofenac, aspirin, ibuprofen
● The combination of these medicines and H. pylori increases the risk of developing a stomach ulcer.
● Has non-ulcer dyspepsia. Eradication therapy may work and clear symptoms but it does not in most cases.
● Has a first-degree relative (mother, father, brother, sister or child) who has been diagnosed with stomach cancer. Treatment is advised even if you do not have any symptoms. The aim is to reduce your future risk of stomach cancer.
● Has unexplaned Iron defeciency anaemia.
● Have a condition called chronic idiopathic thrombocytopenic purpura. This is an uncommon blood condition where the number of platelets in the blood becomes very low. Some research suggests a possible connection between H. pylori infection and this condition.

If you have indigestion (dyspepsia), it is usually only necessary to check to see if the H.pylori has gone if one’s symptoms come back after treatment. If one has a gastric or duodenal ulcer, testing is usually done 6-8 weeks after treatment.

Infection with Helicobacter pylori (H. pylori) is the cause of most stomach and duodenal ulcers. H. pylori also causes some cases of non-ulcer dyspepsia. A test done on a sample of stools (faeces), a breath test, a blood test, or from a biopsy sample taken during a gastroscopy (endoscopy), can confirm infection with H Pylori.. A one-week course of two antibiotic medicines plus an acid-suppressing medicine will usually clear the H. pylori infection. The return of a duodenal or stomach ulcer that had been caused by this infection can be prevented by this.